| ONE
YEAR PROSTATE UROLOGY FELLOWSHIP SPECIALISING IN LAPARASCOPIC
AND ROBOTIC UROLOGY.
Mr Benjamin Eddy, FRCS(Urol), Laparoscopic and Robotic Fellow Royal Adelaide Hospital, Adelaide,
Australia |
 |
Introduction
In February 2008 I started a Urological fellowship at the Royal Adelaide
Hospital specialising in Laparoscopic, Robotic and Pelvic Oncology.
This year is the culmination of 6 years of Urological training that
I have undertaken as a specialist registrar in the South Thames region.
The Royal Adelaide hospital is the largest teaching hospital in South
Australia, it is the regional trauma centre for the state and offers
all services on site except paediatrics. It has a local referral population
of over 1 million but covers a tertiary referral area including Darwin,
Alice Springs and the whole of the Northern Territory. A region over
3000 km end to end.
The Urological department consists of 7 full time and 2 part time consultants (headed by Professor Villus Marshall and Mr Peter Sutherland), 2 middle grades (myself as the fellow and a junior registrar), and one specialist nurse. The department has a large Oncological practice but covers all areas including stone, BPH, female, trauma and reconstruction.
My timetable consists of eight sessions a week in theatres and 2 sessions in outpatients, running a “week on/week off” 1 in 2 on call rota. Working in a high volume centre spending the time predominantly in theatre has, after six months, already given me great experience, learning new techniques more quickly than would be possible in the UK.
Robotic Radical Prostatectomy
Robotic surgery for organ confined prostate cancer was first introduced
at the Royal Adelaide Hospital by Peter Sutherland in November 2004
and currently over 500 cases have been performed, it was the second
robot introduced into Australia and was the first and is still the
only one for public and private patients alike. The benefits of this
operation include a shorter hospital stay, less analgesia requirements,
lower blood loss and transfusion rates and earlier return to normal
activities. The benefits are clearly seen as the majority of our
patients are discharged the day after surgery, this compares to a
3-4 day inpatient stay for the conventional open operation. Currently
around 5-6 cases a week and over 200 for the year will be performed,
giving me an excellent opportunity for training.
The main aim of the fellowship was to be fully trained in this procedure performing it under 3 hours by the end of the year. Under the tuition of Mr Peter Sutherland I have embarked on a truly modular training programme. Initially starting by watching and assisting the operation, I was expected to complete 20 hours of dry lap training on the console and watch pre-recorded operations on DVD before operating on patients. The operation itself has been divided into 10 steps with between five and ten cases for each step being expected to be completed before moving onto the next step. Difficult parts such as the anastomosis have been practiced on the training models before patient operating has been performed. Full access to the robot for training purposes out of hours has been given.
After six months I have been involved in over 70 operations and on the console for around 40 under close supervision by Mr Sutherland, recently completing my first case in around 3 hours. A goal achieved six months ahead of schedule. This exciting technology offers a truly improved level of care for managing men with prostate cancer and hopefully after the year I will be able to provide this exceptional service for patients in the UK.
Laparoscopic Surgery
Laparoscopic or “keyhole” techniques in Urology were initially
pioneered for kidney diseases particularly kidney cancer. I have had
good experience performing these techniques in the UK but wanted to
build on those foundations in Adelaide to obtain complete independent
practice in performing laparoscopic nephrectomy’s. I have been
performing transperitoneal laparoscopic surgery but have also introduced
retroperitoneal techniques to the Royal Adelaide enabling the most rapid
recovery for patients. We have performed 26 laparoscopic procedures
in six months so should hopefully perform 50 cases over the year, an
excellent volume for any department in the UK and we have almost doubled
the number of cases performed here last year. I have also been asked
to help train up another Consultant and the registrar in the department
in performing this surgery. We have a dedicated laparoscopic weekly
operating list which I have made full use of.
Pelvic Oncology
The RAH is also a regional referral centre for managing advanced bladder
cancer and so far this year we have performed 10 cystectomies, an
operation that I am now regularly performing independently.
There is also a high volume of general urology practiced at the RAH in particular BPH and complex stone work which I have also been involved in. I have also had experience in performing many ureteroscopies and supine percutaneous nephrolithotomy, a technique rarely used for stone surgery elsewhere.
General
The department has regular weekly meetings which has given me ample
opportunities for patient discussion, teaching and education. I have
recently attended the Prostate Cancer Symposium in Melbourne organised
by Professor Costello which included live robotic operating, a useful
adjunct to the robotic training at the RAH, and also attended BAUS
in Manchester in June, a trip that was helped funded by Prostate
UK. I have also had time for research submitting 2 abstracts for
the World Congress of Endourology and 2 abstracts for the Urological
Society of Australia and New Zealand meeting for March 2009. I have
also had presentations accepted for the regional South Australia
Urological annual meeting and will plan to submit the RAH robotic
series for BAUS next year. Prostate UK will be credited on all presentations.
While we are here we have taken the opportunity to explore Adelaide and South Australia. The state offers both a great beach lifestyle and stunning countryside only minutes out of town. The state is best known for its wine regions and wine making seems to part of the culture here with 4 world recognised regions only a short drive away. The Barossa has 88 wineries to choose from and is only 1 hour away, McLaren Vale and the Adelaide Hills regions are within 20 minutes. The local sport is Aussie rules football which takes some getting used to but when the cricket season returns trips to the Adelaide Oval will certainly be on the cards.
Once again I would like to offer my thanks to Brigadier John Anderson, Professor Roger Kirby and Prostate UK for their support of this fellowship this year. Support that will hopefully benefit patients with prostate and other urological diseases on my return to the UK.
Project interim progress report by Ben Eddy, 13 August 2008.
Project 2007/01